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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547201111
Report Date: 04/22/2022
Date Signed: 04/22/2022 05:36:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/19/2022 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20220419152028
FACILITY NAME:DAGO RESIDENTIAL FACILITYFACILITY NUMBER:
547201111
ADMINISTRATOR:LOPEZ, TAIMIFACILITY TYPE:
735
ADDRESS:1741 W. VINETELEPHONE:
(559) 713-0145
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY:6CENSUS: 6DATE:
04/22/2022
UNANNOUNCEDTIME BEGAN:
04:44 PM
MET WITH:Administrator Christina SanchezTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Facility food is expired
Food is not stored properly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a complaint investigation and deliver findings. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA explained the purpose of the visit was to deliver findings to Administrator Christina Sanchez.

LPA checked the food, interviewed staff and reviewed submitted photos of expired food and food that was not properly stored.

Based on LPAs interviews and review of photos submitted the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter number, are being cited on the attached LIC 9099D.

Plan of correction and appeal rights was reviewed with Administrator.

An exit interview was conducted and a copy of this report was provided via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20220419152028
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DAGO RESIDENTIAL FACILITY
FACILITY NUMBER: 547201111
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2022
Section Cited
CCR
80076(a)(1)
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80076 Food Services (a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food
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Plan of Correction POC Licensee agrees to complete staff training regarding food storage and the expiration of food by POC due date.
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 Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Based on interviews and photos submited Licensee had expired food and food was not stored properly which poses a potentia Health, Safety or personal rights risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2